Quality Management Clinician - Hybrid

UPMC•Pittsburgh, PA

9h•Hybrid

About The Position

UPMC Community Care Behavioral Health is hiring a full-time Quality Management Clinician to join the Quality team. This is a hybrid role that will work onsite at downtown Pittsburgh's US Steel Tower three days per week. This role will involve some local travel to providers within the Pittsburgh region. The Quality Management Clinician is responsible for performing functions related to quality management and improvement, in compliance with NCQA, HEDIS, URAC and the Commonwealth of Pennsylvania Department of Health quality assurance regulations.

Requirements

Licensed Registered Nurse or Masters Degree required.
3 years clinical experience.
Excellent organizational skills.
Experience in report writing, Microsoft Excel, collection and organization of large quantities of data.
Ability to maintain effective professional liaison with all levels of staff, including professional and institutional providers of care.
Ability to identify trends or problem areas.
Demonstrates clinical knowledge of behavioral health related issues.
Excellent clinical, written and oral communication skills.
Responsiveness to deadlines and has work completed on or before deadline 95%25 of the time.
Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN (with BSN) and/or a licensed PhD (psychologist) preferred.

Nice To Haves

Experience in Quality Management procedures/processes is a bonus.
Knowledge of URAC, NCQA and HEDIS standards is a bonus.

Responsibilities

Responsible for performing targeted, clinical audits and focus studies.
Responsible for logging in, tracking, monitoring, and reporting individual and aggregate complaints and grievances to the Senior Director of Quality Management and other leadership staff members as appropriate. Prepares formal reports and tracks timing of various levels of complaint and grievance for further action.
Responsible for assisting with preparation for NCQA, URAC, and other site visits.
Responsible for participating in updating the QM Plan.
Responsible for monitoring quality tracking reports and providing individual feedback to appropriate staff/committees, and aggregating the data on a monthly basis.
Responsible for identifying trends related to product and participating providers.
Responsible for preparing monthly and quarterly quality improvement reports to the Board.
Responsible for specified data collection related to all functional departments of Community Care.
Responsible for assisting with training responsibilities for providers, Members, and staff on various issues as assigned by the Senior Director of Quality Management.
Responsible for professional and staff development plan.
Responsible for participating in projects as designated by other management staff, such as the Chief Medical Officer and VP of Medical Affairs.